Provider First Line Business Practice Location Address:
225 US 27 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE PLACID
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33852-7920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-699-9977
Provider Business Practice Location Address Fax Number:
863-699-9976
Provider Enumeration Date:
04/03/2012